Levels of Care
An excerpt from Why She Feels Fat by Tony Paulson, PhD
Basic Outpatient Treatment
The most common place for someone to begin is called outpatient treatment. This level of care is appropriate for a person who is medically stable (meaning she doesn't need immediate emergency medical attention or two be admitted into a hospital) and is able to function fairly well in her life even though she has an eating disorder.
This counseling does not necessarily take place in a facility or in a specialized program. Sometimes good outpatient care can be accomplished with a single therapist in an office setting. No matter what the location, though, the therapist is usually the hub of a treatment team and will coordinate communication between its members.
An example of this level of care would be one or more individual therapy sessions, of about an hour each, every week, along with supplemental appointments with a dietitian or psychiatrist. Additionally, the therapist may offer or recommend group therapy or family therapy.
Intensive Outpatient Programs
The next level of care is an intensive outpatient program (IOP), which typically consists of at least three hours of structured treatment per day, provided at a specialized institution. This is a good choice if your loved one tries a less-rigorous outpatient treatment plan but finds it doesn't quite impart enough support or structure for her to make positive changes in her eating behaviors.
IOPs can either replace or be combined with a basic outpatient treatment plan. They provide some combination of individual and family psychotherapy, group therapy, support to help educate families about eating disorders, and nutritional counseling. As with standard outpatient treatment, the IOP team typically consists of a psychotherapist, family therapist, medical practitioner and dietitian. Often there are other clinicians, such as an art, music, or drama therapist.
Remember that someone participating in intensive outpatient programs needs to be medically stable because these programs aren't equipped to provide intensive medical supervision. For this reason, people in IOPs need to continue seeing an outside physician.
Day Treatment Programs
A more comprehensive level of care is a day-treatment or partial hospitalization. This type of treatment offers full-day support, typically six to eight hours per day, usually five days a week, with the patient returning home each night to sleep. The amount of time spent directly in treatment (number of hours per day as well as number of days per week at the program) is what differentiates day-treatment from intensive outpatient treatment.
Day-treatment programs offer a variety of group therapies during the day, as well as several structured meals. Individual therapy, nutritional counseling, and often a family component are included.
For more information or to download a PDF about Day Treatment, please click here (PDF).
Inpatient or Residential Treatment
Inpatient or residential treatment is where your loved one lives at the treatment facility full time. These programs are for those who do not need acute medical care, but who require constant supervision and structure as determined by a physician. Unlike less-intensive levels of care, your loved one lives at the facility 24 hours a day, for as little as four weeks to as long as several months or more.
The inpatient environment is best for individuals who cannot gain weight by themselves, have not been able to alter their eating-disordered behaviors in outpatient settings, or need to be supported and observed during and after all meals. Programs like these can be either hospital-based or exist as a non-medical facility designed to be a safe and comfortable setting that provides all necessary medical and psychological support.
Some inpatient programs cater exclusively to individuals with eating disorders, while others include people with drug or alcohol, or psychiatric problems. In general, the best course of action is to choose a program that has been specifically designed for those who have eating disorders. However, in some cases you might elect to use a facility that offers treatment for a variety of issues. This might be the case, for example, if your loved one has other problems to work on in addition to her anorexia or bulimia, if an exclusively eating-disorders program isn't available in your area, or if the ones that do exist cannot accept your type of insurance.
The most acute level of care is medical hospitalization. Typically, this is advised when your loved one's physical health is significantly compromised and she needs immediate medical attention. In most cases, the hospitalization is relatively short term, with the focus on rehydration (getting her body's fluids back to normal levels), refeeding (getting her to begin eating on a regular basis, or eating without vomiting), and medical stabilization (maintaining vital signs within a relatively normal range). A physician who has been continuously monitoring and observing your loved one's condition during her treatment is the one who will determine if and when medical hospitalization is necessary.
Once your loved one is discharged from the hospital she'll begin or return to her usual treatment routine. In some cases, several medical hospitalizations may be necessary before the individual's health becomes consistently stabilized.